ICD-10 Coding for MRSA(B95.62, A41.02, J15.212)
Complete ICD-10-CM coding and documentation guide for MRSA. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to MRSA
B95-B97Primary Range
Bacterial and viral infectious agents
Includes codes for identifying infectious agents as the cause of diseases classified to other chapters, such as MRSA.
Bacterial pneumonia, not elsewhere classified
Includes codes for pneumonia due to MRSA, such as J15.212.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| B95.62 | Methicillin-resistant Staphylococcus aureus as the cause of diseases classified elsewhere | Use when MRSA is identified as the causative agent of an infection classified elsewhere. |
|
| A41.02 | Sepsis due to Methicillin-resistant Staphylococcus aureus | Use when sepsis is confirmed to be due to MRSA. |
|
| J15.212 | Pneumonia due to Methicillin-resistant Staphylococcus aureus | Use when pneumonia is confirmed to be due to MRSA. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for MRSA
Essential facts and insights about MRSA
Primary ICD-10-CM Codes for mrsa
Decision Criteria
clinical Criteria
- Positive MRSA culture from infection site
coding Criteria
- Sequence infection site code before B95.62
Applicable To
- MRSA as the cause of diseases classified elsewhere
Clinical Validation Requirements
- Lab-confirmed MRSA culture
- Documentation of infection site
Code-Specific Risks
- Incorrect sequencing as primary diagnosis
Coding Notes
- Always sequence the infection site code before B95.62.
A41.02 - Sepsis due to Methicillin-resistant Staphylococcus aureus
Use when sepsis is confirmed to be due to MRSA.
Applicable To
- Sepsis due to MRSA
Clinical Validation Requirements
- Positive blood culture for MRSA
- Clinical signs of sepsis
Coding Notes
Ensure documentation specifies MRSA as the causative agent.
J15.212 - Pneumonia due to Methicillin-resistant Staphylococcus aureus
Use when pneumonia is confirmed to be due to MRSA.
Applicable To
- MRSA pneumonia
Clinical Validation Requirements
- Sputum culture positive for MRSA
- Radiological evidence of pneumonia
Coding Notes
Ensure documentation specifies MRSA as the causative agent.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Methicillin-susceptible Staphylococcus aureus as the cause of diseases classified elsewhere
B95.61Sepsis, unspecified organism
A41.9Unspecified bacterial pneumonia
J15.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting MRSA to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code B95.62.
Impact
Clinical: Incomplete clinical picture, Regulatory: Non-compliance with coding guidelines, Financial: Potential claim denials
Mitigation Strategy
Always document and code the infection site first, Review coding guidelines regularly
Impact
Reimbursement: Claims may be denied if B95.62 is used as the principal diagnosis., Compliance: Non-compliance with ICD-10 sequencing rules., Data Quality: Inaccurate representation of the patient's condition.
Mitigation Strategy
Always sequence the infection site code before B95.62.
Impact
Reimbursement: May lead to claim rejections due to redundancy., Compliance: Violates ICD-10 coding guidelines., Data Quality: Redundant coding affecting data accuracy.
Mitigation Strategy
Do not use Z16.11 with MRSA codes as resistance is inherent.
Impact
Using B95.62 as the principal diagnosis can trigger audits.
Mitigation Strategy
Educate staff on proper sequencing rules.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for MRSA, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for MRSA
Use these documentation templates to ensure complete and accurate documentation for MRSA. These templates include all required elements for proper coding and billing.
MRSA skin infection
Specialty: DermatologyRequired Elements
- Infection site
- Culture results
- Antibiotic susceptibility
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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